| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| L3000 |
Foot, insert, removable, molded to patient model, 'ucb' type, berkeley shell, each |
7,809 |
2,814 |
$1.81M |
| L3216 |
Orthopedic footwear, ladies shoe, depth inlay, each |
4,096 |
1,531 |
$166K |
| L3221 |
Orthopedic footwear, mens shoe, depth inlay, each |
2,537 |
923 |
$121K |
| L3030 |
Foot, insert, removable, formed to patient foot, each |
768 |
322 |
$49K |
| A5500 |
For diabetics only, fitting (including follow-up), custom preparation and supply of off-the-shelf depth-inlay shoe manufactured to accommodate multi-density insert(s), per shoe |
558 |
367 |
$15K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
97 |
92 |
$10K |
| A5512 |
For diabetics only, multiple density insert, direct formed, molded to foot after external heat source of 230 degrees fahrenheit or higher, total contact with patient's foot, including arch, base layer minimum of 1/4 inch material of shore a 35 durometer or 3/16 inch material of shore a 40 durometer (or higher), prefabricated, each |
285 |
186 |
$7K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
25 |
24 |
$4K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
52 |
48 |
$2K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
13 |
13 |
$2K |